Don’t Be Shy About Your Colorectal Health

Northwestern Medicine
Cancer Care/Oncology April 05, 2018
Matt Evangelista, of Glen Ellyn, Ill., isn’t shy about discussing his bowel habits, and he says you shouldn’t be either. A colorectal cancer survivor, Evangelista is quick to share the worst-case scenario with those who want to skip recommended colorectal screenings or are too embarrassed to talk about potential symptoms.

Despite a family history of colon cancer, Evangelista delayed getting a recommended colonoscopy and initially dismissed his symptoms. After some prodding from a friend, he went in for a colonoscopy and the results were devastating – stage 3 rectal cancer.

“I was 47 years old at the time, with a wife and two teenagers. All of a sudden the world came crashing down,” said Evangelista. “My grandfather and my brother both had colon cancer, but I thought since I eat well, exercise and I don’t smoke that I didn’t need to worry. I wasn’t very well educated.”

Evangelista enrolled in a clinical trial at the Northwestern Medicine Cancer Center in Warrenville, Ill., where under the care of medical oncologist Kevin Dawravoo, MD; surgical oncologist Margo Shoup, MD and a team of nurses, genetic counselors and navigators, he underwent 12 rounds of chemotherapy and two surgeries.

“Matt’s cancer was advanced and required intensive treatment. He had a good response to the chemotherapy and through his participation in the clinical trial, we were able to spare him the long-term effects of radiation,” said Kevin Dawravoo, MD, medical oncologist at Northwestern Medicine Cancer Center and Northwestern Medicine Central DuPage Hospital. “The chemotherapy and surgery were successful and Matt is back to living a normal life.”

Combined, colon and rectal cancer are the third most common types of cancer in men and women in the United States. The American Cancer Society estimates that about 140,000 colorectal cancer cases and about 50,000 deaths from colorectal cancer occur each year.

Symptoms can include:
• A change in bowel habits that lasts for more than a few days, such as diarrhea, constipation, or a feeling that your bowel is not empty after a bowel movement
• Bright red or very dark blood in your stool
• Constant tiredness
• Stools that are thinner than usual
• Stools that look slimy or have mucous on them
• Ongoing gas pains, bloating, fullness, or cramps
• Unexplained weight loss
• Vomiting

However, people with colorectal cancer often do not have symptoms right away. By the time symptoms occur, cancer may have grown or spread to other organs. This can make it harder to treat.

“Many patients would never have to see me if they simply got their colorectal screening on time,” said Dr. Dawravoo. “When polyps are diagnosed at an early stage, a gastroenterologist can remove them before they turn into cancer and the patient will not require intensive treatment by an oncologist.”

According to Dr. Dawravoo, lifestyle modifications may help reduce the risk of colorectal cancer, including maintaining a healthy weight, exercising, limiting consumption of red meat, avoiding excessive alcohol intake and not smoking. However, a major risk factor that can’t be controlled is family history.

Evangelista was aware of his family history but didn’t learn until after his cancer diagnosis that he has a hereditary gene mutation that greatly increases his risk for colon cancer. He has since encouraged his siblings to get tested and his children will undergo gene testing in the next few years. If they have the gene mutation, Evangelista says he’ll make sure they do surveillance and follow their doctor’s advice.

“If I had gone in for my colonoscopy when it was recommended, it may have just been a polyp that could have been managed. I chose to wait and look what happened,” said Evangelista. “Now I tell all my friends to stop complaining about the colonoscopy and just get it done. The screening is nothing compared to the alternative if you put it off.”

In an effort to increase colorectal cancer screening rates, Northwestern Medicine Regional Medical Group is participating in the 80% by 2018 initiative. Led by the American Cancer Society, the Centers for Disease Control and Prevention, and the National Colorectal Cancer Roundtable, the initiative asks organizations to pledge to work toward the shared goal of having 80 percent of adults in the United States aged 50 and older regularly screened for colorectal cancer by the end of 2018.

“Despite the benefits, only about 50 to 60 percent of adults nationwide who should be screened are getting screened,” said Hemal K. Patel, MD, gastroenterologist, Northwestern Medicine Regional Medical Group. “Colonoscopy is the only test where a pre-cancerous lesion can be removed, and that can actually prevent cancer in 5, 10, 15 years.”

The American Cancer Society recommends men and women at average risk for developing colorectal cancer should undergo screening starting at age 50. Those at higher risk might need to start colorectal cancer screening before age 50 and/or be screened more often.

For more information on colorectal cancer screening, please call 630.933.2374 or visit

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